29 year old male first presented with unintentional weight loss, fatigue cough and night sweats
CXR Hilar Adenopathy
29-year-old male presents with night sweats
CXR in the PA projection shows bilateral hilar enlargement consistent with hilar adenopathy. Wedge biopsy and culture revealed a diagnosis of MAC (mycobacterium avium complex) The silhouetting of the pulmonary vessels indicates that the soft tissue density arises from the hilum and this case from mediastinal lymph nodes (hilum overlay sign)
Ashley Davidoff MD TheCommonvein.net 135804c 247Lu
29-year-old male presents with night sweats
CXR in the lateral projection shows lobular hilar enlargement consistent with hilar adenopathy. Wedge biopsy and culture revealed a diagnosis of MAC (mycobacterium avium complex)
Ashley Davidoff MD TheCommonvein.net 135805c 247Lu
CT Scan
29-year-old male presents with night sweats
Scout film prior to the CT shows lobular hilar enlargement consistent with hilar adenopathy. Wedge biopsy and culture revealed a diagnosis of MAC (mycobacterium avium complex)
Ashley Davidoff MD TheCommonvein.net 135806 247Lu
Superior Mediastinal Adenopathy-
Mycobacterium avium complex (MAC)
29-year-old male presents with night sweats
CT at the level of the thoracic inlet shows extensive mediastinal adenopathy. Wedge biopsy and culture revealed a diagnosis of MAC (mycobacterium avium complex)
Ashley Davidoff MD TheCommonvein.net 135807 247Lu
Mediastinal Adenopathy- Mycobacterium avium complex (MAC)
29-year-old male presents with night sweats
CT at the level of the A-P window shows extensive mediastinal adenopathy. Wedge biopsy and culture revealed a diagnosis of MAC (mycobacterium avium complex)
Ashley Davidoff MD TheCommonvein.net 135808 247Lu
Subcarinal Adenopathy- Mycobacterium avium complex (MAC)
29-year-old male presents with night sweats
CT at the level of the carina shows extensive subcarinal adenopathy. Wedge biopsy and culture revealed a diagnosis of MAC (mycobacterium avium complex)
Ashley Davidoff MD TheCommonvein.net 135810 247Lu
29-year-old male presents with night sweats
CT at the level of the left atrium shows extensive hilar and mediastinal lymphadenopathy. Wedge biopsy and culture revealed a diagnosis of MAC (mycobacterium avium complex)
Ashley Davidoff MD TheCommonvein.net 135812 247Lu
Normal Upper Abdominal Examination
29-year-old male presents with night sweats
CT in the a plane of the upper abdomen shows no retroperitoneal adenopathy and normal sized spleen. Remaining organs are unremarkable
Ashley Davidoff MD TheCommonvein.net 135811 247Lu
Mycobacterium avium complex (MAC)
Micronodules Small Airway Disease-
29-year-old male presents with night sweats
CT at the level of the carina shows extensive accumulation of ground glass micronodules and noted regions of tree in bud morphology. Wedge biopsy and culture revealed a diagnosis of MAC (mycobacterium avium complex)
Ashley Davidoff MD TheCommonvein.net 135813c 247Lu
Lady Windermere Syndrome
61 year old male with a history of treated mycobacterial infections and chronic cough
Frontal view shows shaggy heart borders with bibasilar cystic changes consistent with bronchiectasis in the middle lobe and lingula
Ashley Davidoff MD TheCommonVein.net 250Lu 135871
61-year-old male with a history of treated mycobacterial infections including MAC and chronic cough.
Coronal CT at the level of the heart shows significant bronchiectasis to the middle lobe and lingula and as a result abut the right and left heart border accounting for the CXR findings of a “shaggy heart border”. There is a relative paucity of mucus in the ectatic airways. The history of MAC and the distribution of the bronchiectasis in the middle lobe and lingula are reminiscent of the diagnosis of Lady Windermere syndrome
Ashley Davidoff MD TheCommonVein.net 250Lu 135879
61-year-old male with a history of treated mycobacterial infections including MAC and chronic cough.
Axial CT at the level of the mid to lower chest shows mildly ectatic segmental airways to the lower, and middle lobe bronchi but significant bronchiectasis to the middle lobe and lingula involving the subsegmental airways. There is a relative paucity of mucus in the ectatic airways. The history of MAC and the distribution of the bronchiectasis in the middle lobe and lingula are reminiscent of the diagnosis of Lady Windermere syndrome
Ashley Davidoff MD TheCommonVein.net 250Lu 135876
61-year-old male with a history of treated mycobacterial infections including MAC and chronic cough.
Axial CT at the level of the mid to lower chest shows mildly ectatic segmental airways to the lower, and middle lobe bronchi (teal arrowheads (b and c) but significant bronchiectasis to the middle lobe and lingula involving the subsegmental airways (yellow arrowheads b and c). There is a relative paucity of mucus in the ectatic airways. The history of MAC and the distribution of the bronchiectasis in the middle lobe and lingula are reminiscent of the diagnosis of Lady Windermere syndrome
Ashley Davidoff MD TheCommonVein.net 250Lu 135877cL
Segmental Subsegmental and Small Airway Disease Micronodules
29-year-old male presents with night sweats
CT at the level in the lower lung fields shows thickening of the segmental airway subtending the lateral basal segment of the right lower lobe and extending into the small airways and the secondary lobule. In addition there are innumerable ground glass nodules. Wedge biopsy and culture revealed a diagnosis of MAC (mycobacterium avium complex)
Ashley Davidoff MD TheCommonvein.net 135814c 247Lu
Micronodules
29-year-old male presents with night sweats
CT shows innumerable ground glass nodules most prominent in the right upper lobe but also apparent in the right lower lobe. Wedge biopsy and culture revealed a diagnosis of MAC (mycobacterium avium complex)
Ashley Davidoff MD TheCommonvein.net 135815 247Lu
Centrilobular Nodules and Micronodules
29-year-old male presents with night sweats
CT shows innumerable ground glass nodules most prominent in the right upper lobe but also apparent in the right lower lobe and left apex. The inserts in the lower panel, highlight the centrilobular nodules (white arrowheads), thickening and irregularity of the interlobular septa likely with lymphatic involvement (pink arrowheads) and suggestion of nodules along the pulmonary venules (red arrowheads). Wedge biopsy and culture revealed a diagnosis of MAC (mycobacterium avium complex)
Ashley Davidoff MD TheCommonvein.net 135816c02L 247Lu
Micronodules Centrilobular Nodules,
Thickened Nodular Interlobular Septa
29-year-old male presents with night sweats
CT in the coronal plane in the posterior aspect of the chest shows innumerable ground glass micronodules most scattered throughout both lung fields. The inserts in the lower panel, highlight the centrilobular nodules (white arrowheads) and thickened nodular changes in the interlobular septa and along the venules, likely due to lymphatic involvement. Wedge biopsy and culture revealed a diagnosis of MAC (mycobacterium avium complex)
Ashley Davidoff MD TheCommonvein.net 135817cL 247Lu